Updated: 8/16/2018

Metastasis

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Introduction
  • Spread of a neoplasm to distant tissues
  • Cellular requirements
    • invasive carcinoma progression that reaches a blood or lymph vessel
    • increased angiogenesis at metastatic foci
    • non-reversible changes
  • May spread hematogenously or via lymphatics
    • sarcomas most commonly spread via blood
    • carcinomas most commonly spread via lymphatics
      • most notable exceptions include renal cell carcinomas, follicular carcinomas of the thyroid, and hepatocellular carcinoma
        • all prefer hematogenous spread
  • If neoplasm is multifocal and well-circumscribed, strongly consider metastasis
    • multiple independent cancers are rare 
  • Most common sites of metastasis include
    • lung
    • liver
      • metastasis much more common than primary tumors
    • brain
      • metastasis equivalent in frequency to primary tumors
    • bone
      • metastasis much more common than primary tumors
    • lymph nodes are the most common site of metastasis
  • These organs receive a large proportion of blood supply making metastatic seeding more likely in these areas
Metastasis to brain
  • Due to blood flow patterns and masses normally present at gray-white border
  • Primary tumors that metastasize to brain include
    • lung > breast > skin (melanoma) > kidney (renal cell carcinoma) > GI
      • pulmonary circulation immediately enters the brain once leaving left heart
Metastasis to liver
  • The liver and lung are the most common sites of metastasis after the regional lymph nodes
  • Primary tumors that metastasize to the liver include
    • colon > stomach > pancreas > breast > lung
      • colon drained by portal vein which empties into liver
Metastasis to bone
  • Primary tumors that metastasize to the bone include
    • prostate = breast > thyroid > testes > lung > kidney
    • vertebrae seeded by Batson's venous plexus
  • Metastasis to bone may be bone forming (blastic) or bone destructive (lytic)
    • lung = lytic 
      • presents with hypercalcemia
    • prostate = blastic
      • presents with high alkaline phosphatase
    • breast = both lytic and blastic

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